Medicine Health Care and Philosophy最新文献

The European Union regulations for research on human and nonhuman participants differ significantly. This study aims to present a thorough analysis of these differences in the field of biomedical research. The study consists of a review of regulations issued by the European Union and Council of Europe institutions, supported by two UNESCO documents. The regulations are compared between three types of research: on humans, on nonhuman animals, and research using human embryos, within five categories: (1) Justification and scope of the regulations; (2) Inclusion criteria; (3) Consent procedures; (4) Participants' welfare; and (5) Values in research. In each category, significant differences between regulations for humans and animals are presented. These differences can be ethically analyzed in terms of values pursued in the protection of participants (intrinsic value of humans vs. value of animal welfare) and hierarchies of values in regulations (priority of participant-centered values in research on humans vs. priority of research-centered values in research on animals). Since the current protection of animals in biomedical research based on the '3Rs' principles seems not adequate, two possible ways forward are analyzed: replacement of all animals in research with other methods and a shift to research on companion animals.

UK Biobank is a major biomedical database and research resource, holding the genetic, health, and lifestyle information of half a million adult volunteers. Its datasets are accessible to approved researchers from academic, charity, government, and commercial organisations for health-related research in the public interest. Drawing upon a range of approved projects and the downstream applications of this research, I suggest that UK Biobank datasets have been processed towards ends that are inimical to its stated aims, breaking the terms of consent under which its participants entered the study. First, I provide an overview of the broad consent model employed by UK Biobank in recruiting participants and using their data. The consent documents and participant information leaflets used exhibit information failures in their framing of health-research in terms of disease and treatment, obscuring the full range of lawful uses of participants' data. Beyond this, certain approved uses of UK Biobank data, including studies by insurance companies and direct-to-consumer genetic testing companies, arguably fall outside UK Biobank's stated aims altogether. Moreover, UK Biobank has not adequately safeguarded against "dual use" issues. Tracking the trajectory of research outputs that used biobank data, I suggest that approved uses of biobank datasets have gone on to have objectionable further applications that are not in the public interest. Such applications include the development of polygenic scores that seek to predict "intelligence" for use in commercial embryo screening services. Such tools are rife with risk of harm and are being deployed without sufficient public deliberation or oversight.

In this paper I analyze the phenomenon of normalizing and tabooing menstrual pain as an example of epistemic injustice. I refer to both types of epistemic injustice distinguished by Miranda Fricker: testimonial injustice and hermeneutic injustice. The social approach to the phenomenon of menstrual pain combines both. This poses a significant political and bioethical problem, as ignoring and misunderstanding the experiences of menstrual pain sufferers can contribute to delayed diagnosis and reinforce patients' sense of loneliness.

Digital mental healthcare technologies increasingly incorporate gamification, yet relevant ethical considerations remain underexamined. This paper introduces the Principle-Based Empirically Grounded Roadmap Approach (PERA), a methodological contribution to empirical bioethics. It has evolved from ethics research within the Horizon Europe project ASPbelong, which designs a collaboratively played augmented reality intervention for adolescents. PERA refines existing integrated empirical bioethics methodologies by responding to three key characteristics of the use case: a largely predetermined technology with a relatively low degree of openness in technological design, embedded co-development practices led by facilitators from within the project team, and planned future iterations beyond the ethics team's involvement. PERA integrates mapping of principles from the ethics literature, a scoping review of the moral intuitions of developers of comparable technologies, and the collection of original empirical data on the use case. Using abductive reasoning, these insights are synthesized into a tangible output: an ethics roadmap designed to guide and be adapted in future use case iterations. By advancing a methodology of combining normative reasoning with empirical insights on a concrete use case, this paper provides both practical tools for ethics researchers in technology projects and a means to generate empirically grounded conceptual contributions. Its outcomes, when brought into dialogue with findings from other integrated empirical bioethics research, can support the critical examination of broader assumptions and implications of gamified mental healthcare, including questions of good care and the broader social implications of such technologies.

Differently from pre-technological societies, the contemporary one, when faced with pain, always thinks it can prepare a therapeutic response using the technique as the most valid form to dominate it. However, medicalization and pharmacology of pain prevent it from becoming language. Thus, medical progress makes men much more vulnerable to pain. If, on the one hand, the benefits of anesthesia constitute an unparalleled achievement, on the other, they generate a sense of indifference to life. This is precisely why it is important and urgent to return to listening to the cry of pain. In this sense, particularly commendable were the efforts of Cicely Saunders, who dedicated her entire life to listening to pain and made listening to pain the cornerstone of the philosophy of the Hospice Movement. Therefore, this paper aims to propose a reconstruction of the phenomenology of terminal pain that emerges in Cicely's writings, highlighting its particularity and usefulness in designing a better approach to pain management. Terminal pain has a strong ethical dimension that requires not only a therapeutic but, above all, an ethical response. The proposal of care that derives from Saunders' reflections focuses on the direct encounter with the other caught in its aspect of contact and restores importance to the medical art imagined as "pathic," which, based on a complete or comprehensive wisdom, surpasses the classical humanistic vision and dichotomy which separates it from the purely biomedical one.

The debate on whether psychiatric disorders can be studied as natural kinds has raised controversy, reviving socio-constructionist arguments about the influence of social factors on psychiatric categories. A key concept in this discussion is the "looping effect", which describes how individuals change in response to their classifications, necessitating revisions to those classifications. We argue that, until now, the broad discussions around the looping effect have greatly failed to integrate the perspectives surrounding clinicians and patients. We examine more closely the dynamic and unstable nature of psychiatric diagnoses by proposing two key hypotheses: first, that understanding the looping effect requires incorporating both clinician and patient viewpoints, and that when done adequately, such an incorporation can facilitate the work of the clinician by creating feedback loops (i.e., the iterative adjustment of clinical interpretations based on patient responses); and second, that epistemic injustices between clinicians and patients can create disruptions in these feedback loops, which we call "looping breaks", rendering them ineffective. Looping breaks can happen at the clinical level of the relationship between the patient and the clinician or at the nosological level (during the process of revising a classification). We suggest that looping breaks can be caused by a denial or minimization of credibility based on identity prejudice, or due to an epistemic disadvantage, affecting the experiential feedback of patients following the announcement of a diagnosis. To substantiate our claims, we first examine the impact of looping effects in the interaction between patients and clinicians. Second, we investigate the impact of these interactions at the nosological level, on the broader diagnostic framework. We identify epistemic injustices as critical factors that can lead to looping breaks at both levels, thus affecting the stability and validity of psychiatric diagnoses. Our findings underscore the importance of an epistemic approach to the looping effect, emphasizing both knowledge validity and justice in clinician-patient relationships and among clinicians themselves.

This article presents the findings of a "normativity mapping review" designed to make visible the breadth of normative understandings at work within interdisciplinary scholarship on end-of-life care in long-term care institutions. The scope of the literature was limited to peer-reviewed articles authored by scholars affiliated with institutions in Austria, Germany, and Switzerland. Terms and slogans associated with the hospice movement were used as keywords to search for literature in both German and English. During data analysis, values, frameworks, and actions were systematically extracted from the articles. Actions were then clustered into four groups: one involving actions aimed at planning future end-of-life decision-making; another focused on transforming cultures of care; a third encompassing end-of-life practices; and a fourth consisting of residual actions. A comparison of two of these groups shows that normative understandings of end-of-life care in long-term care institutions take shape around two poles-a procedural pole, involving standardised tools that can be used in specific practices to address challenges and improve care, and a substantive pole, centred on the embodied competencies and moral sensibilities of caregivers in realising visions of good end-of-life care.

Compassion is an essential phenomenon in the therapeutic relationship, and some use it to justify physician-assisted dying practices. The value of compassion in the relationship between healthcare professionals and patients is undeniable. However, different approaches to its definition and scope can lead to distinct conclusions about the role of compassion in end-of-life interventions. In this context, the paper aims to compare Mahatma Gandhi's and Aristotle's views on compassion to explore whether it can be utilized to justify physician-assisted dying. Gandhi's thoughts on compassion and Aristotle's standpoint on virtues and vices demonstrate that Gandhi evaluates this concept as a moral duty to relieve intractable suffering, whereas Aristotle relies on balancing all virtues through relevant deficiencies and excesses. Therefore, even though Gandhi's opinion on compassion can for allow assisted dying interventions, Aristotle's idea of virtues and vices restricts compassion to a scope that alleviates suffering through available means without causing death.

It has been difficult historically for physicians, patients, and philosophers alike to quantify pain given that pain is commonly understood as an individual and subjective experience. The process of measuring and diagnosing pain is often a fraught and complicated process. New developments in diagnostic technologies assisted by artificial intelligence promise more accurate and efficient diagnosis for patients, but these tools are known to reproduce and further entrench existing issues within the healthcare system, such as poor patient treatment and the replication of systemic biases. In this paper we present the argument that there are several ethical-epistemic issues with the potential implementation of these technologies in pain management settings. We draw on literature about self-trust and epistemic and testimonial injustice to make these claims. We conclude with a proposal that the adoption of epistemic humility on the part of both AI tool developers and clinicians can contribute to a climate of trust in and beyond the pain management context and lead to a more just approach to the implementation of AI in pain diagnosis and management.

Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry.